Monday, July 6, 2009

Doc puts inmates' mental health first

It's become a given among mental health professionals that jails are now the largest psychiatric hospitals in the country. In Bexar County, as in others around the nation, roughly one out of four inmates suffers from some kind of mental illness.

That translates into some 800 inmates at the county jail being treated for a psychiatric disorder — hundreds more than patients being cared for at the San Antonio State Hospital.

Dr. Sally Taylor, administrator of psychiatric services at Bexar County Jail, has been on the front lines of the struggle to treat and rehabilitate mentally ill prisoners.

Before that, she was the medical director of the psychiatric emergency room at University Hospital for 17 years, dealing with some of the most disturbed and violent patients and training scores of medical students and other health professionals.

But she's done more than that. By all accounts, Taylor has been a tireless advocate for the mentally ill in San Antonio, working with local advocacy groups to reduce stigma about mental illness, encourage churches to address mental disorders and promote education and community awareness about mental disease.

Recently, she worked with other mental health groups on legislation to compel mentally ill prisoners to take their medication.

This is important for those who have been found incompetent to stand trail and are in jail awaiting transfer to an inpatient competency restoration program.

This will allow treatment for those with severe mental illness who are a danger to self or others or who lack the capacity to understand the risk of refusing treatment, and who have been excluded from court ordered treatment simply because they are located in jail.

It might even help some inmates enough that they could enter outpatient competency restoration.

The bill was signed into law by Gov. Rick Perry.

Because of her work, Taylor was recently one of 41 psychiatrists around the country to be given the prestigious 2009 Exemplary Psychiatrist award by the National Alliance on Mental Illness, for which she was nominated by the local NAMI chapter.

“Psychiatrists who are honored have really gone the extra mile,” said Michael Fitzpatrick, executive director for NAMI. “We awarded Dr. Taylor not only for her work in (University Hospital's psychiatric ER) but for her engagement with us on policy, corrections and faith-based initiatives. She's just outstanding.”

Yolanda Alvarado, chairwoman of the Bexar County Mental Health Task Force, said Taylor was the driving force behind the compelled medication legislation.

“I know that it came from her brain,” Alvarado said. “She got the judges involved, too. She actually went to testify. Because she's a doctor, she carries such credibility.”

Speaking from her office inside the jail, Taylor, who earned her medical degree from the University of Texas Health Science Center, said mentally ill people off their medication often commit petty crimes — criminal mischief and the like — then wind up in jail.

Before the legislation she worked on became law, they couldn't be compelled to take medication in jail, unlike in mental health facilities. They would be judged incompetent to stand trial.

“And then what happens is they end up languishing in jail for two or three months because there are no open beds at the state hospitals,” she said.

“And for all that time they're deteriorating and getting worse. I worry that some of these people might never be restored because the brain stays sick for so long.”

Sometimes an inmate goes into the state hospital for competency restoration, then comes back to the jail and again refuses medication — which sends him or her back to the hospital. It's becomes a cycle.

Taylor, to appease advocacy groups that resist the idea of compelled medication, helped craft the legislation to apply only to those inmates who are deemed a danger to themselves or others.

But her goal is not just to help restore sick inmates to competency. In 2008 she advocated for more than 100 inmates who had committed misdemeanor crimes to have their charges dropped so they could then enter treatment programs, rather than incarceration.

“In coordination with the district attorney's office, the probate court, the jail staff and the Center for Health Care Services, we were able to get civil commitments sending them to the state hospital,” she said. “That may not sound like a lot of people, but for us it was a brand new process, and it became a well-oiled process.”

Taylor applauds the city's award-winning jail diversion program, which trains police officers to recognize mentally ill law-breakers and take them to ERs and other treatment facilities instead of jail.

But she said much more needs to be done with regard to the long-term needs of mentally ill lawbreakers.

“We do a great job recognizing the (mentally ill) at the front door, but the problem is the back door,” she said. “Bexar County is one of the lowest counties in per capita funding for mental health in Texas, and Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

“You can do all the screening and all the jail diversion that is possible, and I'm completely in favor of that, but you've got to have services for people when you send them out in the world.”

Too often, she said, released mentally ill inmates confront a host of obstacles on the outside that hobble them in being compliant with their medical care. And then they re-offend.

“If somebody comes to the jail because it's a place to sleep and eat, you want to be able to provide that on the outside,” she said. “We don't have enough residential units, we don't have enough housing, we don't have enough supported employment, we don't have support services, we don't have intensive case management. So we drop the ball.”

Taylor, who swims and makes jewelry to de-compress from her high-pressure job, said she is drawn to working with the prison population because she is able to help give voice to the voiceless.